The clinical use of the term “spotting” refers to episodes of slight bleeding that do not require the use of a pad or tampon. The term “breakthrough bleeding” commonly indicates a level of bleeding that requires the use of a product. However, these terms can be misleading since they are often used interchangeably, even in the medical literature.
Altering the time by a few hours is generally okay, but if you alter your dose by four hours or more, then you are altering how your body absorbs the birth control pills and naturally produces hormones. This may lead to spotting. It may also decrease the effectiveness of the birth control pills, which can increase your short-term chances of getting pregnant. Pick a time that is convenient and that is the most likely to time you will remember. Try taking them last thing before bed, in the morning when you brush your teeth, or at another time when you consistently perform other daily activities like taking your shower or going for your morning walk. If you don’t like the time you picked and want to adjust, wait until you start the next new pack. Adjust your scheduled dose time with a fresh pack to be sure you do not compromise the way the pills work in your body. Adjusting your time mid-cycle can increase your chance of spotting as well as getting pregnant.
If your pack contains pills that are different in color, it is especially important to take them in the exact order as they are in the package. Colored tablets contain different strengths of hormones to provide the amount of hormones your body needs at different times of the month. Even if your pills are all the same color, take them in the order they are in the package. This can help you and your doctor identify any problems you may have, such as spotting, at a particular part of your cycle.
If you miss a pill, ask your doctor when to take the missed dose and if added protection is needed to prevent pregnancy. However, these questions do not have simple answers. The answers vary depending on three primary factors. The factors include the type of pills you are taking, where you are in your cycle when you miss the pill, and if you missed more than one pill in a row.
If you miss the very first pill in a new pack, take the missed pill as soon as you remember and take the next pill at the normal time. It is okay to take two pills in one day. Use a backup form of birth control until you have taken the next seven tablets on schedule. If you miss a pill during the cycle, take it as soon as you remember. Take the next pill at the normal time. It is okay to two pills in one day. If you have a 28 day pill pack, and you miss a dose during the last week, or tablets 21 thru 28, then you are not at risk of getting pregnant. Start your new pack as you would according to your regular schedule.
If you miss two pills in a row during the first or second week, take two tablets on the day you remember and two tablets the following day. This will put you back on your normal schedule. Use another form of birth control until you begin new cycle and a fresh pack of pills. If you miss two pills in a row during the third week, then use another method of birth control until it is time to start a new pack. You can discard the remainder of the pack you were in when you missed the two pills in the latter part of your cycle. If you miss three or more pills in a row anytime during the cycle, then you should use another method of birth control and you will need to start a new pack. Contact your doctor for clear instructions as to when to start the new pack. In some cases you may need to wait until your menstrual cycle occurs and start the new pack as you normally would. Your doctor may want you to start another pack sooner than that, depending on the type of birth control pills you are taking and how long until your menstrual cycle would normally begin. Be sure to use other forms of birth control until you have taken seven days of your new pack.
Women who smoke more than 15 cigarettes a day and are over 35 years old should not take birth control. Smoking cigarettes while taking birth control pills has been proven to greatly increase the risk of serious side effects. Some examples of the serious complications that can occur from smoking and taking birth control pills include blood clots, liver tumors, and stroke.
Recent research has shown that birth control pills are equally effective in women that are overweight as they are in women of average weight. There are still questions about significant changes in weight, either weight gain or loss, and how that may alter the body’s general metabolism, normal production of hormones, and the effects on birth control pill absorption and metabolism.
While it is true that some vitamins, supplements, and even foods, can interfere with the way your body absorbs the hormones in birth control pills, this is not a recommended method of trying to self-adjust your dose. Consult your doctor before you use vitamins, supplements, and some foods and beverages to try to alter your absorption of your birth control pills. These methods are not established in scientific research and are not recommended. There are many well-researched options available to balance the hormones in the birth control pills to match the needs of your body. Some examples of vitamins, herbal supplements, and foods that alter the absorption of the hormones in birth control pills include vitamin C, St. John’s Wort, and grapefruit juice. If these agents are part of your regular routine, let your doctor know.
Alterations in cortisol levels influence how your body uses available hormones. This can lead to abnormalities in your menstrual cycle and may include spotting and breakthrough bleeding even when taking birth control pills. Take steps to consistently manage the stress in your life. This may include participating in a new exercise routine or learning stress management tools such as yoga, meditation, and mindfulness exercises. Learn how to use breathing and relaxation techniques to control unexpected stressful circumstances.
See your doctor for new episodes of spotting. The spotting or breakthrough bleeding may be caused by something unrelated to your birth control pills. If you are continuing on the same regimen of birth control pills but begin to experience mid-cycle bleeding, this may be a symptom of another problem and should be evaluated by your doctor. Breakthrough bleeding may be a sign of other problems including pregnancy or conditions involving cervical changes. If you have made lifestyle changes such as smoking, or have started taking new medications that may be interacting with the birth control pill regimen, this can cause breakthrough bleeding as well.
If you continue to have problems with spotting or breakthrough bleeding on your current pill, talk to your doctor about either switching to another strength or extending the number of days you take active pills vs the placebo pills at the end of most packs. There are many types of pills that are effective at preventing pregnancy. Finding the best one to suit the hormonal needs of your body is simply a matter of being patient and trying a few different types. Doctors routinely start with products that contain the lowest possible amounts of either estrogen, progesterone, or both. Changing to a brand with a slightly higher dose of estrogen usually stops the problem with spotting and breakthrough bleeding. Some packages are now designed to extend your days of active pills by taking advantage of a 3 month cycle as opposed to the usual 1 month pill pack. By switching to a 3 month cycle, you may have less trouble with your periods and fewer problems with spotting and breakthrough bleeding. Talk to your doctor about this option.
Consider being patient and open to trying other types of birth control pills. Realize that stopping your birth control pills means you will need to find another method of birth control. Birth control pills are one of the most effective and convenient ways to prevent pregnancy. Other methods are often less reliable, inconvenient, and sometimes require interruptions during sexual intercourse.
If you are having any problems with new or persistent bleeding, make an appointment as soon as possible for an evaluation. Vaginal bleeding can be a symptom of a medical condition, including some that are serious such as cervical cancer. In addition, your doctor may want to perform screening tests for sexually transmitted disease or other problems on a routine basis, possibly annually, depending on your personal circumstances. Birth control pills do not protect from sexually transmitted diseases. Let your doctor know as soon as possible if you think you may have acquired a sexually transmitted disease.
Drugs that can interfere with the effectiveness of your pill can include everything from over-the-counter herbal supplements to antibiotics. Both short and longer term use of some antibiotics can alter the effectiveness of your birth control pills. If you are prescribed an antibiotic for any reason, it is important to let your doctor know since your birth control regimen may be less effective. Some antiseizure medications can also interfere with the effectiveness of your birth control pills. Seizure medications are sometimes used to treat mood disorders and chronic pain syndromes such as migraine headaches. Some herbal supplements, especially St. John’s wort, may also interfere with hormonal birth control. Always ask your doctor or pharmacist about the need to use backup birth control when you are taking something new.
Some medical conditions may warrant closer monitoring for women that are taking birth control pills. Examples include diabetes, a history of cardiovascular disease, and a history of breast disease. If you get a virus, the flu, or a stomach condition that includes nausea, vomiting, and diarrhea, let your doctor know. The symptoms alone can alter the absorption of your birth control pills. This means they are probably less effective during this time and you may need to use another method of birth control until you are feeling better for at least seven days.
